ATC-20 Detailed Evaluation Safety Assessment Form

Inspection Final Posting

from page 2
Inspector ID:
Inspected
Affiliation: Restricted Use
Inspection date and time: AM PM Unsafe

Building Description Type of Construction

Building name: Wood frame Concrete shear wall
Address: Steel frame Unreinforced masonry
Tilt-up concrete Reinforced masonry
Concrete frame Other: _______________
Building contact/phone:
Primary Occupancy
Number of stories above ground: below ground:
Dwelling Commercial Government
Approx. “Footprint area” (square feet):
Other residential Offices Historic
Number of residential units: Public assembly Industrial School
Number of residential units not habitable: Emergency services Other: _______________

Evaluation
Investigate the building for the conditions below and check the appropriate column. There is room on the second page for a
sketch.
Minor/None Moderate Severe Comments
Overall hazards:
Collapse or partial collapse
Building or story leaning
Other
Structural hazards:
Foundations
Roofs, floors (vertical loads)
Columns, pilasters, corbels
Diaphragms, horizontal bracing
Walls, vertical bracing
Precast connections
Other
Nonstructural hazards:
Parapets, ornamentation
Cladding, glazing
Ceilings, light fixtures
Interior walls, partitions
Elevators
Stairs, exits
Electric, gas
Other
Geotechnical hazards:
Slope failure, debris
Ground movement, fissures
Other
General Comments:

Continue on page 2
 ATC-20 Detailed Evaluation Safety Assessment Form Page 2

Building name: Inspector ID:

Sketch (optional)
Provide a sketch of the building or
damaged portions. Indicate damage
points.

Estimated Building Damage

If requested by the jurisdiction,
estimate building damage (repair
cost ÷ replacement cost, excluding
contents).
None
0–1%
1–10%
10–30%
30–60%
60–100%
100%

Posting
If there is an existing posting from a previous evaluation, check the appropriate box.
Previous posting: INSPECTED RESTRICTED USE UNSAFE Inspector ID: __________ Date:______
If necessary, revise the posting based on the new evaluation and team judgment. Severe conditions endangering the overall
building are grounds for an Unsafe posting. Local Severe and overall Moderate conditions may allow a Restricted Use posting.
Indicate the current posting below and at the top of page one.
INSPECTED (Green placard) RESTRICTED USE (Yellow placard) UNSAFE (Red placard)
Record any use and entry restrictions exactly as written on placard:

Further Actions Check the boxes below only if further actions are needed.
Barricades needed in the following areas:

Engineering Evaluation recommended: Structural Geotechnical Other:

Other recommendations:

Comments:

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Permission is granted for unlimited, non-exclusive, non-commercial use and distribution of ATC evaluation forms, provided that this Copyright Notice appears on all copies and the Applied
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